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In the twelfth of our 16 blogs for 16 days, Lucy Downes, Project Lead for Social Franchising at IRISi talks about the real life impact the IRIS programme has on women all across the UK.

IRIS is a specialist domestic violence and abuse (DVA) training, support and referral programme for General Practices that has been positively evaluated in a randomised controlled trial.

IRIS is a collaboration between primary care and third sector organisations specialising in DVA.  Core areas of the programme include ongoing training, education and consultancy for the clinical team and administrative staff, care pathways for primary health care practitioners and an enhanced referral pathway to specialist domestic violence services for patients with experience of DVA.

IRISi is a not-for-profit social enterprise established to improve the healthcare response to gender-based violence. IRIS is our flagship intervention and so we support areas to commission, implement and maintain the IRIS programme. I have written and spoken the words above about the IRIS programme tens, or even hundreds, of times since joining the team at IRISi as a Regional Manager over two years ago. These words go into our presentations, our training resources, and our promotional materials. I know them off by heart. 

I can talk at length now about the robust evidence base for the effectiveness of IRIS and about its cost effectiveness. I can write about how it is considered the gold standard for an intervention to improve the general practice response to domestic abuse, cited as it is in numerous regional and national strategies and policies. I can explain how IRIS enables clinicians and general practices to meet the NICE guidelines and standards (2014 and 2016) on domestic abuse. I write about and speak about IRIS to and with lots of different types of audiences – commissioners in CCGs, in Public Health, and in other local commissioning bodies, chief execs and service managers in domestic abuse services, and academics, researchers and evaluators working in the sector.

My work, and our work at IRISi, is often focussed on discussions and decisions happening between commissioners and domestic abuse service managers: what is the patient population in the area in which commissioners wish to see IRIS implemented? How large a local IRIS team will be needed? How much will it cost to implement IRIS? What impact can be achieved for a budget of £X? What are the expected outputs and outcomes of the IRIS programme? How are the outcomes going to be evidenced and reported on?

Whilst the words at the top trip easily off my tongue now it’s easy to forget what they actually mean. Discussions and decisions about budgets, staff recruitment, outcomes and evidence are necessary, because they enable the IRIS programme to happen in a particular area, but it’s easy to become wrapped up in these discussions and distant from the difference that the IRIS programme makes to people at the level of individuals.

Then, every once in a while, something I read or hear something that a patient has said that stops me in my tracks and brings into sharp focus why we all do our jobs:

‘Thank you for listening’

‘Thank you for helping’

 ‘So SO good to talk to [the AE], to feel believed, to feel understood, to realise what happened to me was not my fault & to see things differently. Thank you.’

‘Thank you, that first meeting was hard, but the help & support I have received has changed my life.’

‘Whatever you have going on with GPs in [IRIS area] is so important – that link is incredible – I am forever indebted to my GP for piecing it all together and for getting me that help.’

This is what IRIS does. These are the outcomes. This is the impact. Forget for a minute about the numbers, about working out what percentage of the patient population have been referred and whether targets or KPIs have been met. Listen to what patients say about the IRIS programme. 

For victims and survivors, being listened to, heard and understood is the necessary first step towards safety, choice, empowerment and freedom.

The chance to speak to an experienced domestic abuse specialist in a safe and familiar environment can be life changing for victims and survivors of domestic abuse. 

Of course, domestic abuse services other than IRIS provide support to victims and survivors to increase their safety, enable them to make informed choices, and to make dramatic changes in their lives and those of their children. But the final patient who I have quoted says something that is fundamental to the IRIS programme: the link between the IRIS advocate educator and the general practices she trains and works with is ‘incredible’. This link is what we mean when we write that ‘IRIS is a collaboration between primary care and third sector organisations specialising in DVA’. And ‘piecing it all together’ is what IRIS enables clinicians to do through the provision of the ‘training, support and referral programme for general practices’  that we talk and write of so often.Without IRIS training, GPs and other general practice clinicians often have not had the training to equip them with the knowledge and skills to piece together the symptoms and conditions experienced by their patients with the possibility that these symptoms are linked to domestic abuse. 

IRIS isn’t just about training though. Training helps clinicians to identify and ask about DVA, but training alone rarely brings about long term positive change to the general practice response to domestic abuse. The final patient quoted says ‘I am forever indebted to my GP for piecing it all together and for getting me that help’.  Getting patients that help is crucial. IRIS is as much about the referral pathway for patients, and the ongoing support provided by the AE to the practice team, as it is about the training. It is this referral pathway and support that enables clinicians to feel confident to ask about domestic abuse; the availability of a named, known and trusted advocate educator, who can visit patients in the safety and familiarity of their own practice, means that clinicians know exactly what to do, and what to expect, if a patient answers ‘yes, this is affecting me’. Through this combination of training, a referral pathway, and ongoing support, the IRIS programme enables a sustained change in the way in which clinicians address and respond to domestic abuse. Ultimately this change in clinical practice changes patients’ lives profoundly. So next time we’re wrapped up in the language and concerns of commissioning, budgets and management, let’s remember what patients tell us about the IRIS programme.

Lucy Downes is Project Lead for Social Franchising at IRISi. For more information on how IRIS can help you and your practice, please get in contact with us here.

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The IRIS Programme provides specialist advocacy and support to patients registered at IRIS-trained practices who have experienced domestic abuse.

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Partners

AVA
AVA
AVA

AVA is an expert, groundbreaking and independent charity working across the UK.

Their vision is a world without gender based violence and abuse. They aim to  inspire innovation and collaboration and encourage and enable direct service providers to help end gender based violence and abuse particularly against women and girls.AVA’s work is focused around those areas where they can make the best contribution to ending violence and abuse. They do this by making sure that survivors get the help and support they need in the here and now, through providing innovative training that has a proven direct impact on the professional practice of people supporting survivors of violence and abuse

developing a range of toolkits, e-learning and other material that supports professionals to provide effective and appropriate support to survivors of violence and abuse

using our influence and networks to ensure survivors voices are heard. We work closely with AVA in many areas including the Pathfinder project

https://avaproject.org.uk

SafeLives
SafeLives
SafeLives

SafeLives are a national charity dedicated to ending domestic abuse, for good. We combine insight from services, survivors and statistics to support people to become safe, well and rebuild their lives. Since 2005, SafeLives has worked with organisations across the country to transform the response to domestic abuse, with over 60,000 victims at highest risk of murder or serious harm now receiving co-ordinated support annually. SafeLives are members of the Pathfinder consortium.

http://www.safelives.org.uk/about-us

IMKAAN
IMKAAN
IMKAAN

Imkaan is a UK-based, Black feminist organisation. We are the only national second-tier women’s organisation dedicated to addressing violence against Black and minoritised women and girls i.e. women and girls which are defined in policy terms as Black and ‘Minority Ethnic’ (BME). The organisation holds nearly two decades of experience of working around issues such as domestic violence, forced marriage and ‘honour-based’ violence.

They work at local, national and international level, and in partnership with a range of organisations, to improve policy and practice responses to Black and minoritised women and girls. Imkaan works with it’s members to represent the expertise and perspectives of frontline, specialist and dedicated Black and minoritised women’s organisations that work to prevent and respond to violence against women and girls. Imkaan delivers a unique package of support which includes: quality assurance; accredited training and peer education; sustainability support to frontline Black and minoritised organisations; and facilitation of space for community engagement and development. They are a part of the Pathfinder Consortium.

https://www.imkaan.org.uk

The University of Bristol CAPC
The University of Bristol CAPC
The University of Bristol CAPC

The Centre for Academic Primary Care (CAPC) is a leading centre for primary care research in the UK, one of nine forming the NIHR School for Primary Care Research.  It is part of Bristol Medical School, an internationally recognised centre of excellence for population health research and teaching.

A dedicated team of researchers at the Centre work on domestic abuse projects and IRISi is a co-collaborator and partner on some of these projects including ReProvide, HERA and DRiDVA.

The Health Foundation
The Health Foundation
The Health Foundation

The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK. The Health Foundation’s Exploring Social Franchising programme aims to generate a deeper understanding of the potential of social franchising models for scaling effective health and social care interventions within the NHS.

We are one of four project teams participating in the programme to develop a social franchise to enable the sustainable spread of our intervention, the IRIS Programme. We receive funding and support from the Health Foundation, including technical expertise on social franchising, and attend programme learning events. The Health Foundation has also commissioned a programme-wide evaluation to support understanding of the use of social franchising in the UK health and care system. We and our franchisees will support the evaluation through co-designing data collection requirements, providing access to data as requested, hosting site visits and attending learning events.

https://www.health.org.uk

STADV
STADV
STADV

Standing Together Against Domestic Violence is a UK charity bringing communities together to end domestic abuse. They bring local services together to keep people safe

Most public services weren’t designed with domestic abuse in mind, and they often struggle to keep people safe. Poor communication and gaps between services put survivors at risk.

STADV aim to end domestic abuse by changing the way that local services respond to it. They do this through an approach that they pioneered, called the Coordinated Community Response. The Coordinated Community Response brings services together to ensure local systems truly keep survivors safe, hold abusers to account, and prevent domestic abuse.

Their model of a coordinated local partnership to tackle and ultimately prevent domestic violence is now widely accepted as best practice. They are also a part of the Pathfinder consortium.

http://www.standingtogether.org.uk

Spring Impact
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Spring Impact is a not-for-profit social enterprise born out of the frustration of seeing social organisations constantly reinventing the wheel and wasting scarce resources. Spring Impact uses a combination of tested commercial and social principles and extensive practical expertise to support organisations to identify, design and implement the right social replication model to scale their social impact.

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